摘要目的 评价山东省地方性氟中毒(地氟病)病区X线检查成像质量,为正确实施X线检查提供依据.方法 在山东省20个地氟病县(市、区)各选择3个病村作为调查点,X线拍摄村民的前臂(包括肘关节)和小腿(包括膝关节)正位片,每村拍摄20张,每张包括2个拍摄部位.其中14个县(市、区)的42个病村X线检查由山东省地方病防治研究所承担,共拍摄X线片840张,编为A组,其余6个县(市、区)由当地医院拍摄X线片360张,编为B组.依照检查技术要求和诊断指标来确定X线片审片项目,分照片表面缺陷、结构缺陷、综合质量三个层面对比观察A与B组X线片质量差异.结果 在照片表面缺陷评定中,A组缺陷指标总检出率前臂片为7.98％(67/840),小腿片为9.77％(82/840);B组分别为35.27％(127/360)和39.16％(141/360),两组比较差异有统计学意义(x2值分别为138.6、144.0,P均＜0.01).在照片结构缺陷评定中,A组结构缺陷总检出率前臂片为7.14％ (60/840),小腿片为8.33％ (70/840);B组分别为27.22％ (98/360)和31.38％(113/360),两组比较差异有统计学意义(x2值分别为88.867、103.6,P均＜0.01).在照片综合质量评定中,A组优质率前臂片为72.73％(611/840),小腿片为71.67％ (602/840),而质差率分别为9.89％(83/840)和11.43％ (96/840);B组优质率为44.14％(159/360)和42.22％ (152/360),质差率为34.74％(125/360)和38.06％ (137/360),两组比较差异有统计学意义(Z值分别为-20.161、-16.229,P均＜0.01).结论 由县(市、区)自拍摄的X线片缺陷较多、图像较差,其原因与当地医院X线技师技术水平参差不齐,照片质量要求不严有关,应定期成立上级专业技师监管队伍,到现场督导摄片和审片,推行以防治单位为主体的流动X线检查,以便提供可靠的技术保障.

abstractsObjective To evaluate the photo quality of X-ray films of endemic fluorosis in Shandong Province,and to provide a basis for correct implementation of X-ray examination.Methods Three villages were selected as survey sites in each of the 20 endemic fluorosis counties (cities,districts) of Shandong Province;anteroposterior X-ray films of the villagers forearm(including elbow) and leg(including knee) were taken; 20 films were taken in each village,each film comprising two recording sites.X-ray examination carried out in the 42 patients' villages of 14 counties(cities,districts) were undertaken by the Institute for Endemic Disease Control,Shandong Province,a total of 840 X-ray films shoot,which was edited group A,and the remaining six counties (cities,districts) were undertaken by the local Hospital,shooting X-ray films 360 copies,compiled for group B.The quality of X-ray film examination was determined in accordance with technical requirements and diagnostic indicators.The difference of photo quality between group A and group B was compared at three levels:sub-surface defects photos,structural defects and comprehensive quality.Results In evaluation of surface defects in the photo,the total detection rate of the defects indicators in group A of forearm was 7.98％(67/840),while the rate of leg was 9.77％(82/840).And the rates of group B were 35.27％(127/360) and 39.16％(141/360),respectively,and the differences were statistically significant between the two groups(x2forearm=138.6,P ＜ 0.01 ; x2leg =144.0,P ＜ 0.01).In assessment of structural defects,the total forearm defection rate of group A was 7.14％(60/840),and the leg was 8.33％ (70/840).And the rates of group B were 27.22％ (98/360) and 31.38％ (113/360),respectively.The differences were statistically significant(x2forearm =88.867,P ＜ 0.01; x2leg =103.6,P ＜ 0.01).In the photo quality comprehensive assessment,the excellent rate of forearm in group A was 72.73％(611/840),and the leg was 71.67％ (602/840),while the poor quality rates in the same parts were 9.89％ (83/840) and 11.43％ (96/840),respectively.And the excellent rates of Group B were 44.14％(159/360) and 42.22％(152/360),poor quality rates were 34.74％(125/360) and 38.06％(137/360).The differences were statistically significant(Z value were-20.161 and-16.229,respectively,P ＜ 0.01).Conclusions X-ray films taken in the counties (cities,districts) have more defects,and image is poor.The reason for that is that the skill levels of local hospital X-ray technician are low,and photos quality is not strictly followed requirements.Supervision team of professional technicians should be established to provide professional supports.It is more important to take mobile X-ray examination by the provincial institutes,and to provide a reliable technical support.